NCLEX practice questions Chapter 6: Health and Wellness

Many variables influence a patient's health beliefs and practices. Internal and external variables influence how a person thinks and acts. An example of an internal variable would be a. Perception of functioning. b. Family practices. c. Socioeconomic factors. d. Cultural background.

ANS: A Internal variables include a person's developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors. External variables influencing a person's health beliefs and practices include family practices, socioeconomic factors, and cultural background.

Which activity represents secondary prevention? a. A home health care nurse visits a patient's home to change a wound dressing. b. A 50-year-old woman with no history of disease attends the local health fair and has her blood pressure checked. c. The school health nurse provides a program to the first year students on healthy eating d. The patient attends cardiac rehabilitation sessions weekly

a. A home health care nurse visits a patient's home to change a wound dressing.

A male patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been seeing his pastor to help him through this difficult time. He does not have a primary health care provider because he has never really been sick and his parents never took him to the physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) a. Difficulty paying his bills b. Seeing his pastor as a mean of support c. Family practice of not routinely seeing a health care provider d. Stress from the divorce and the loss of a job

a. Difficulty paying his bills c. Family practice of not routinely seeing a health care provider d. Stress from the divorce and the loss of a job

When taking care of patients, the nurse routinely asks them if they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? a. Holistic b. Health belief c. Transtheoretical d. Health promotion

a. Holistic

The nurse is participating at a health fair at the local mall giving influenza vaccines to senior citizens. What level of prevention is the nurse practicing? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quaternary prevention

a. Primary prevention

The nurse is conducting a home visit with an older adult couple. She assesses that the lighting in the home is poor and there are throw rugs throughout the home and a low footstool in the living room. She discusses removing the rugs and footstool and improving the lighting with the couple. The nurse is addressing which level of need according to Maslow? a. Physiological b. Safety and security c. Love and belonging d. Self-actualization

b. Safety and security

A patient at the community clinic asks the nurse about health promotion activities that she can do because she is concerned about getting diabetes mellitus since her grandfather and father both have the disease. This statements reflects that the patient is in what stage of the health belief model? a. Perceived threat of the disease b. Likelihood of taking preventative health action c. Analysis of perceived benefits of prevention action d. Perceived susceptibility to the disease

d. Perceived susceptibility to the disease

A 62-year-old male patient has had chronic obstructive pulmonary disease (COPD) for many years but has been unable to quit smoking. When approached by the nurse, he states that he would be "better off dead." He states that he has always supported his family, and now the doctor says he can no longer work because of his condition and oxygen dependency. His wife will now have to go to work, and he is sure that she will not make enough money to pay the bills. In preparing the patient for discharge, the nurse should a. Develop a plan of care for the family. b. Contact psychiatric services. c. Assure the patient that things will work out. d. Focus the plan of care on maximizing patient function.

ANS: A Because of the effects of illness, family dynamics often change. The nurse must view the whole family as a patient under stress, planning care to help the family regain its maximal level of functioning and well-being. Psychiatric services may be a part of that plan but do not represent the entire plan. Offering false assurance is never acceptable.

The nurse is working in a clinic that is designed to provide health education and immunizations. As such, this clinic is designed to provide a. Primary prevention. b. Secondary prevention. c. Tertiary prevention. d. Diagnosis and prompt intervention.

ANS: A Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration.

The nurse is working in a drug rehabilitation clinic and is in the process of admitting a patient who says that she wants to be "detoxified." It is important for the nurse to a. Identify the patient's stage of change. b. Realize that the patient is ready to change. c. Instruct the patient that she will have to change her lifestyle. d. Instruct the patient that relapses are not tolerated.

ANS: A Processes of change, or nursing interventions, should be appropriately chosen to match the stage of change. Most behavior change programs are designed for those people who are ready to take action regarding their health behavior problems. Only a minority of people are actually in this action stage. Changes will be maintained over time only if they are integrated into an individual's overall lifestyle. As individuals attempt a change in behavior, relapse followed by recycling through the stages occurs frequently.

The nurse is preparing a smoking cessation class and is amazed at how many people still smoke even with the information on lung cancer so readily available. She believes that her class will convert many smokers to nonsmokers once they get all the latest information. The nurse is a believer in which of the following health care models? a. Health Belief Model b. Health Promotion Model c. Basic Human Needs Model d. Holistic Health Model

ANS: A The Health Belief Model addresses the relationship between a person's beliefs and behaviors. The Health Promotion Model is more complex than the Health Belief Model in that it notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Basic Human Needs Model is based on the theory that all people share basic human needs, and the extent to which basic needs are met is a major factor in determining a person's level of health. The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. Education is important but is not the sole determinant of change.

Models of health offer a perspective by which to understand the relationships between the concepts of health, wellness, and illness. Nurses are in a unique position to assist patients in achieving and maintaining optimal levels of health because nurses (Select all that apply.) a. Understand the challenges of today's health care system. b. Identify actual and potential risk factors. c. Have coined the term "illness behavior." d. Can minimize the effects of illness and assist to the return of optimal health

ANS: A, B, D Nurses are in a unique position to assist patients in achieving and maintaining optimal levels of health. Nurses understand the challenges of today's health care system and embrace the opportunity to use wellness activities to promote health and wellness and to prevent illness. Nurses can identify actual and potential risk factors that predispose a person or group to illness. Nurses who understand how patients react to illness can minimize the effects of illness and assist patients and their families in maintaining or returning to the highest level of functioning. Medical sociologists call the reaction to illness "illness behavior."

The patient had a colostomy placed 1 week ago. When approached by the nurse, the patient and his wife refuse to talk about it and refuse to be taught about how to care for it. The nurse realizes that the patient and his wife are in which stage of adjustment? a. Shock b. Withdrawal c. Acceptance d. Rehabilitation

ANS: B As the patient and family recognize the reality of a change, they become anxious and may withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists the patient in making the adjustment. Initially, the patient may be shocked by the change. This is followed by withdrawal, acknowledgment when they accept the loss, and rehabilitation when the patient is ready to learn how to adapt.

According to the World Health Organization, what is the best definition for "health"? a. Simply the absence of disease b. Involving the total person and environment c. Strictly personal in nature d. Status of pathological state

ANS: B Nurses' attitudes toward health and illness should consider the total person, as well as the environment in which the person lives. All people free of disease are not equally healthy. Views of health have broadened to include mental, social, and spiritual well-being, as well as a focus on health at family and community levels. Conditions of life, rather than pathological states, are what define health.

The patient is admitted to the emergency department of the local hospital from home with reports of chest discomfort and shortness of breath. She is placed on oxygen, has labs and blood gases drawn, and is given an electrocardiogram and breathing treatments. What level of preventive care is this patient receiving? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: B Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration.

Risk factors can be placed in the following interrelated categories: genetic and physiological factors, age, physical environment, and lifestyle. The presence of any of these risk factors means that a. A person with the risk factor will get the disease. b. The chances of getting the disease are increased. c. The disease is guaranteed not to develop if the risk factor is controlled. d. Risk modification will have no effect on disease prevention.

ANS: B The presence of risk factors does not mean that a disease will develop, but risk factors increase the chances that the individual will experience a particular disease or dysfunction. Control of risk factors does not guarantee that a disease will not develop. However, risk factor identification assists patients in visualizing those areas in life that can be modified or even eliminated to promote wellness and prevent illness.

The patient has been overweight for most of her life. She has tried dieting in the past and has lost weight, only to regain it when she stopped dieting. She is visiting the weight loss clinic/health club because she has decided to do it. She states that she will join right after the holidays, in 3 months. The nurse recognizes that the patient is in which stage of the change process? a. Precontemplation b. Contemplation c. Preparation d. Action

ANS: B These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). This patient is planning to make the change within the next 6 months and is in the contemplation stage.

The nurse is caring for a patient who has been trying to quit smoking. She has been smoke free for 2 weeks but had two cigarettes last night and at least two this morning. What should the nurse anticipate? a. The patient does not want to and never will quit smoking. b. The patient will return to the contemplation or precontemplation phase. c. The patient will need to adopt a new lifestyle for change to be effective. d. The patient must pick up her attempt right where she left off.

ANS: B When relapse occurs, the person will return to the contemplation or precontemplation stage before attempting the change again. The patient cannot pick up her attempt where she left off. It is believed that change involves movement through a series of stages. These stages range from no intention to change (precontemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintenance. The action phase indicates a desire to change and a potential to do so. Changes will be maintained over time only if they are integrated into an individual's overall lifestyle.

The nurse is admitting a patient with uncontrolled diabetes mellitus. It is the fourth time the patient is being admitted in the last 6 months for high blood sugars. During the admission process, the nurse asks the patient about her employment status and displays a nonjudgmental attitude. Why does the nurse do this? a. Noncompliant patients thrive on the disapproval of authority figures. b. External variables have little effect on compliance. c. A person's compliance is affected by economic status. d. Employment status is an internal variable that impacts compliance.

ANS: C A person's compliance with treatment is affected by economic status. A person tends to give a higher priority to food and shelter than to costly drugs or treatments. A person generally seeks approval and support from social networks, and this desire for approval affects health beliefs and practices. Internal and external variables influence how a person thinks and acts toward health care. Employment status is an external variable, not an internal variable.

To increase quality and years of healthy life, Healthy People 2020 focuses on four areas. One of those areas is a. Allowing people to continue current behaviors to reduce the stress of change. b. Focusing only on individual health changes that will lead to better communities. c. Creating social and physical environments that promote good health. d. Focusing on illness treatment to provide fast recuperation.

ANS: C Healthy People 2020 includes four goals, one of which is to create social and physical environments that promote good health for all. The other three include (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; and (3) promote quality of life, healthy development, and healthy behaviors across all life stages.

An argument for passing "universal health care" legislation is that it would help fulfill the Healthy People 2020 goal of a. Increasing quality of life in America. b. Prolonging healthy life in America. c. Eliminating health disparities in America. d. Promoting healthy behaviors.

ANS: C Healthy People 2020 promotes a society in which all people live long, healthy lives. This program has four overarching goals: (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, healthy development, and healthy behaviors across all life stages. Providing health care to all would eliminate disparities in health care by ensuring access. Perhaps the best way to increase quality and years of healthy life is to promote healthy behaviors. However, providing access to health care would not guarantee changes in behaviors, increased quality of life, or prolonged healthy life.

A patient is admitted to a rehabilitation facility following a stroke. The patient has right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and speech therapy. What are these examples of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: C Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. Secondary prevention focuses on individuals who are experiencing health problems or illnesses, and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities.

The health care model that utilizes Maslow's hierarchy as its base is the _____ Model. a. Health Belief b. Health Promotion c. Basic Human Needs d. Holistic Health

ANS: C The Basic Human Needs Model believes that the extent to which basic needs are met is a major factor in determining a person's level of health. Maslow's hierarchy of needs is a model thahe Health Belief Model addresses the relationship between a persot nurses use to understand the interrelationships of basic human needs. Tn's beliefs and behaviors. The Health Promotion Model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy.

Just as health and health behavior are affected by internal and external variables, so are illness and illness behavior. Which external variables can affect illness and behavior? (Select all that apply.) a. Perception of the seriousness of the illness b. Patient's coping skills c. Cultural background d. Social support e. Socioeconomic status

ANS: C, D, E External variables influencing a patient's illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support. Internal variables include the patient's perceptions of symptoms and the nature of the illness, as well as the patient's coping skills and locus of control.

The nurse is working on a committee to evaluate the need for increasing the levels of fluoride in the drinking water of the community. In doing so, the nurse is fostering the concept of a. Illness prevention. b. Active health promotion. c. Wellness education. d. Passive health promotion.

ANS: D Fluoridation of municipal drinking water and fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. With active strategies of health promotion, individuals are motivated to adopt specific health programs such as weight reduction and smoking cessation programs. Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Wellness education teaches people how to care for themselves in a healthy way.

The patient is describing moderate incisional pain that was not relieved by the last dose of hydromorphone (Dilaudid) given 90 minutes earlier. The patient is not due for another dose of medication for another 2 1/2 hours. The nurse repositions the patient, asks what type of music she likes, and puts on the music channel on the television, setting it to play that type of music. The nurse is attempting to utilize which health care model? a. Health Belief Model b. Health Promotion Model c. Basic Human Needs Model d. Holistic Health Model

ANS: D The Holistic Health Model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. The Health Belief Model addresses the relationship between a person's beliefs and behaviors. The Health Promotion Model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The Basic Human Needs Model believes that the extent to which basic needs are met is a major factor in determining a person's level of health. Maslow's hierarchy of needs is a model that nurses use to understand the interrelationships of basic human needs.

The patient has quit smoking and has been smoke free for the past 2 years. Of the following stages, which best fits her current stage of change? a. Contemplation b. Preparation c. Action d. Maintenance

ANS: D These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). Because she has been smoke free for 2 years, she is in the maintenance stage.

Many variables influence a patient's health beliefs and practices. Internal and external variables influence how a person thinks and acts. An example of an internal variable would be a. Perception of functioning. b. Family practices. c. Socioeconomic factors. d. Cultural background.

a. Perception of functioning. Internal variables include a person's developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors. External variables influencing a person's health beliefs and practices include family practices, socioeconomic factors, and cultural background.

The nurse is developing a health promotion program on healthy eating and exercise for high school students using the health belief model as a framework. Which statement made by a nursing student is related to the individuals perception of susceptibility to an illness? a. "I don't have time to exercise because I have to work after school every night." b. "I am worried about becoming overweight and getting diabetes because my father has diabetes." c. "The statistics of how many teenagers are overweight is scary." d. "I've decided to start a walking club at school for interested students."

b. "I am worried about becoming overweight and getting diabetes because my father has diabetes."

A patient comes to the local health clinic and states: "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the patient through the stages of change for exercise? a. "Walking is OK. I really think running is better. b. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?" c. "Yes, I want you to begin walking. Walk for 30 minutes every day and start to eat more fruits and vegetables." d. "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes if you are going to do any good"

b. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?"

The nurse assesses the following risk factors for coronary artery disease (CAD) in a male patient. Which factors are classified as genetic and physiological? (Select all that apply.) a. Sedentary lifestyle b. Father died from CAD at age 50 c. History of hypertension d. Eats diet high in sodium e. Elevated cholesterol level f. Age is 44 years

b. Father died from CAD at age 50 c. History of hypertension e. Elevated cholesterol level f. Age is 44 years

When illness occurs, different attitudes about it cause people to react in different ways. What do medical sociologists call this reaction to illness? a. Health belief b. Illness behavior c. Health promotion d. Illness prevention

b. Illness behavior

Based on the transtheoretical model of change, what is the most appropriate response to a patient who states: "Me, exercise? I haven't done that since junior high gym class, and I hated it then!" a. "That's fine. Exercise is bad for you anyway." b. "OK. I want you to walk 3 miles 4 times a week, and I'll see you in 1 month." c. "I understand. Can you think of one reason why being more active would be helpful for you?" d. "I'd like you to ride your bike 3 times this week and eat at least four fruits and vegetables every day."

c. "I understand. Can you think of one reason why being more active would be helpful for you?"

A patient experienced a myocardial infarction 2 weeks ago and is currently participating in the daily cardiac rehabilitation sessions at the local fitness center. In what level of prevention is the patient participating? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quaternary prevention

c. Tertiary prevention

A patient with a 20-year history of diabetes mellitus had a lower leg amputation. Which statement made by the patient indicates that he is experiencing a problem with body image? a. "I just don't have the energy to get out of bed in the morning." b. "I've been attending church regularly with my wife since I got out of the hospital." c. "My wife has taken over paying the bills since I have been in the hospital." d. "I don't go out very much because everyone stares at me."

d. "I don't go out very much because everyone stares at me."

The patient states that she has joined a fitness club and attends the aerobics class three nights a week. The patient is in what stage of behavioral change? a. Precontemplation b. Contemplation c. Preparation d. Action

d. Action

A nurse works in a special care unit for children with severe immunology problems and is caring for a 3-year-old boy from Greece. The boy's father is with him while his mother and sister are back in Greece. The nurse is having the difficultly communicating with the father. What action does the nurse take? a. Care for the boy as she would any other patient b. Ask the manager to talk with the father and keep him out of the unit c. Have another nurse care for the boy because maybe that nurse will do better with the father d. Search or help with interpretation and understanding of the cultural differences by contacting someone from the local Greek community

d. Search or help with interpretation and understanding of the cultural differences by contacting someone from the local Greek community